Thursday, March 19, 2020

The coronavirus, or COVID-19, may cause fear, anxiety, or confusion for many children and youth. While Social Narratives have been shown to be an effective strategy for children with autism, they are appropriate for individuals of any age who may be experiencing challenges with social communication. Social Narratives can help alleviate fears and anxiety many children may be experiencing at this time and help them cope during the coming days and weeks.

Wednesday, March 4, 2020

The problem behaviors of
children on the autism spectrum (ASD) are among the most challenging
and stressful issues faced by many schools and parents. The current best practice in
treating and preventing undesirable or challenging behaviors utilizes the principles
and practices of positive behavior support (PBS). PBS is not a specific
intervention per se, but rather a set of research-based strategies that are
intended to decrease problem behaviors by designing effective environments and
teaching students appropriate social and communication skills. PBS utilizes primary (school-wide), secondary (targeted group), and tertiary (individual) levels or tiers of intervention, with each tier providing an increasing level of intensity and support.

PBS Strategies in the Classroom

Other than families,
teachers are the most influential resource for students with and without special needs. Although functional behavior assessment (FBA) and intensive individual support is recommended for students with serious and persistent challenging behaviors, teachers may prevent the possibility of problematic behavior through the implementation of class-wide and targeted group PBS strategies. For example, effective prevention of challenging social behavior can be
addressed through arranging the classroom environment and/or by adapting
instruction and the curriculum. Changing the classroom environment or
instruction may lessen the triggers or events that set off the challenging
behavior. Teaching effective social interaction and communication as
replacements for challenging behavior is also a preventive strategy for
improving little used student social interaction and communication skills.
Teachers can model, demonstrate, coach, or role-play the appropriate
interaction skills. They can teach students to ask for help during difficult
activities or negotiate alternative times to finish work. Encouraging positive
social interactions such as conversational skills will help students with
challenging behavior to effectively obtain positive peer attention. The
following are examples of PBS strategies for improving social skills and
prosocial behaviors in the classroom (Vaughn, Duchnowski, Sheffield, &
Kutash, 2005; Wilkinson, 2017).

Initiating interactions. Teachers
might notice that when a student with autism enters the classroom, group activity,
or other social interaction, they may have particular difficulty greeting
others students or starting a conversation. For example, they may joke, call
another student a name, laugh, or say something inappropriate. In this
situation, the student may have trouble initiating interactions or
conversations. The teacher might talk to the student individually and offer
suggestions for ways he or she can provide an appropriate greeting or introduce
a topic of conversation. The student might then be asked to practice or
role-play the desired behavior.

Example:“why don’t you
ask students what they did last night, tell them about a TV show you watched,
or ask if they finished their homework, rather than shouting or saying ‘Hey,
Stupid.’ Other students in the class want to be your friend, but you make it
difficult for them to talk with you. Let’s practice the next time the class
begins a new group activity.”

Maintaining interactions. Many autistic students struggle to maintain a conversation (e.g.., turn taking).
Some may dominate the conversation and make others feel that they have nothing
to contribute, while other students may experience difficulty keeping up with
the flow of conversation and asking questions. Students may also have limited
topics of interest and discuss these topics repetitively.

Example: “I’ve noticed that
other students cannot share their thoughts and ideas with you when you start a
conversation because you do all the talking. It may seem to them that you don’t
care what they have to say. Other students will be more willing to talk if you
stop once you’ve stated your idea or opinion and allow them a turn to talk.
When you stop, they know you are listening. You can say to them, “What do you
think?” or “Has this ever happened to you?’”

Terminating interactions. Some
students with autism may not know how to appropriately end a conversation. They
may abruptly walk away, start talking with another student, or bluntly tell a
student they don’t know what they’re talking about. Other students may
interpret this as rude and impolite behavior. Teachers might point out to the
student some ac­ceptable ways of ending a conversation.

Example: “You just walked
away from that student when they were talking. Rather than walk away, you might
say “‘I have to go now,’ ‘It’s time for my next class,’ ‘Or ‘I’ll see you later
and we can finish our talk.’”

Recognizing body language.
The recognition of body language or nonverbal cues is critical to successful
social interactions. Autistic students typically have difficulty interpreting
these cues from teachers or other students. Body language tells students when
they violate a person’s personal space, a person needs to leave, or they need
to change behavior. Teachers can incorporate these skills into their class time
or school day.

Example:Before leaving
the classroom, demonstrate nonverbal cues by holding a finger to your
lips and telling students that means “quiet,” a hand held up with palm facing outward means “wait” or “stop,” and both hands pushing downward means “slow
down.” You may need to demonstrate facial expressions you use to “deliver
messages” and what they mean. Other students can demonstrate nonverbal cues
they use. When students move through the halls, you may want to teach them the
“arms length” rule for personal space.

Transitions. Many students
with autism have significant problems changing from one activity to the next or
moving from one location to another. They may be easily upset by abrupt changes
in routine and unable to estimate how much time is left to finish an activity
and begin the next one. Poor executive function skills such as disorganization
may also prevent them from putting materials away from the last activity or
getting ready for the next activity. They may also need closure and preparation
time for the transition. Problems arise if the teacher tries to push them to
transition at the last minute.

Example:About 10 minutes
prior to the transition, refer to the classroom schedule and announce when the
bell will ring or when the next activity will begin. Provide a 5-minute and
then a 1-minute warning. This countdown helps students finish assignments or
end favorite activities. For students that have difficulty getting started
after a transition, place assign­ment folders on their desks so that they have
their assignments and don’t have to wait for instructions or materials. They
can use the same folder to submit assignments (the folders can be left on their
desks at the end of the period).

Conclusion

Students on the autism spectrum often
lack the social skills to communicate and interact effectively with peers and
adults. They may use challenging or disruptive behavior to communicate their
needs. These examples illustrate how PBS provides a proactive framework for
assessing social interaction and communication needs and for teaching new,
effective skills that replace the challenging behavior. When used consistently,
these strategies fit within the framework of the classroom and can help promote
positive student behavior.

Tuesday, March 3, 2020

The basic principle of CBT is that we mainly feel the way we think,
and that anxiety and depression originate in our irrational beliefs or
cognitive distortions. In other words, illogical and unrealistic thinking can
lead to feelings of anxiety and depression and affect your psychological
well-being. CBT, by definition, teaches people to monitor their own thoughts,
ideas, and perceptions with the goal of becoming more aware of their
interpretive errors. CBT builds a set of skills that enables an individual to
be aware of thoughts and emotions; identify how situations, thoughts, and
behaviors influence emotions; and improve feelings by changing dysfunctional thoughts
and behaviors.

Lee A. Wilkinson, PhD, NCSP is a licensed and nationally certified school psychologist,chartered psychologist, and certified cognitive-behavioral therapist. He provides consultation services and best practice guidance to school systems, agencies, advocacy groups, and professionals on a wide variety of topics related to children and youth with autism spectrum disorders. Dr. Wilkinson is author of the award-winning book, Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT.

Sunday, March 1, 2020

Anxiety Disorders are a
frequent co-occurring (comorbid) problem for children and youth with autism spectrum disorder (ASD).
Although prevalence rates vary from 11% to 84%, most studies indicate that
approximately one-half of children with ASD meet criteria for at least one
anxiety disorder. Of all types of anxiety disorders, specific phobia is
the most common, with prevalence estimates ranging from 31% to 64%. In contrast,
estimates of phobias in children in the general population range from 5% to
18%.

Unusual fears have long
been recognized as a feature of autism. In fact, 70 years ago, Leo Kanner wrote
in his initial account of autism that “loud noises and moving objects” are
“reacted to with horror” and things like “tricycles, swings, elevators, vacuum
cleaners, running water, gas burners, mechanical toys, egg beaters, even the
wind could on occasions bring about a major panic.” We now know that children
with autism perceive, experience, and respond to the world very differently
than children without autism. Experiences that may be tolerable for most typical
children might be frightening, disturbing, or irritating for a child with ASD.
Children with autism may also be unresponsive to other experiences (e.g.,
insensitive to pain), may not show stranger or separation anxiety, and may be seemingly
unaware of obvious dangers (e.g., running into traffic).

Research

Previous research
examining the types and frequencies of fears in children with autism have found
odd and intense fears in approximately 40% of children with autism, whereas
unusual fears were present in only 0–5% of children without autism, including
children with a learning disability, language disorder, ADHD, intellectual
disability, and typical development. Studies also indicate that while some of
the most common fears for children with autism and typical development overlap,
children with autism have frequent fears that were not amongst the most frequently
reported for typical children. These include fear of thunderstorms, large crowds,
and closed spaces.

A large scale study
reported in Research in Autism Spectrum Disordersinvestigated unusual
fears in a sample of 1033 children ages 1-16 with autism. The purpose of the
study was to categorize and determine specific types of unusual fears in children
with autism as well as identify variables related to the presence or absence of
these fears. Unusual fears were reported in 421 (40.8%) of the 1033 children
with autism. A total of 487 unusual fears were reported, representing 92 different
fears. The most common unusual fears in three or more children with were toilets, elevators, vacuum cleaners, thunderstorms, heights, and visual media(characters in or segments of movies, television shows, commercials, or computer games). Many children also had common childhood fears and phobias
(including fear of dogs, bugs, spiders, snakes, the dark, doctors, barbers,
monsters, people in costumes, mechanical toys, sleeping alone, fire, and swimming),
which increased the overall proportion of children with autism who had intense
fears and phobias to more than 50%.

§Visual
media (Characters in or
segments of movies, television shows, commercials, computer games)

Types and Frequency of
Unusual Fears

Unusual fears reported by
parents fell into two categories: (1) uncommon fears not typically reported in
children in the general population or in children with specific phobias and (2)
fears that have been reported in studies of children without autism but which
were considered unusual by parents because of their intensity, obsessiveness,
irrationality, or interference with functioning. Of the total number reported, the
most common unusual fears in three or more children with autism were:

§Toilets

§Elevators

§Vacuum
cleaners

§Thunderstorms

§Tornadoes

§Heights

§Visual
media

Associated variables

Children with and without
unusual fears did not differ in age, IQ level, mental age, autism severity,
race or parent occupation. Of all the demographic variables, only female gender
was associated with the presence or absence of unusual fears. More girls had
unusual fears (48.8%) than did boys (39.1%). This is consistent with the
earlier studies indicating that girls with autism had more fears than boys and with
general population studies showing that girls had more fears and higher fear survey
scores than boys. The finding that children with and without unusual fears did
not differ in age suggests that unlike most typical children, those with autism
may not outgrow unusual fears. Likewise, the findings regarding autism severity
and parent occupation suggest that the presence of unusual and intense fears
may be present across SES and the entire autism spectrum. The authors note that
the lack of demographic differences in the study may suggest a neurobiological
basis for fears overriding developmental and environmental influences.

Implications

Research suggests that it
is critical to assess for unusual and intense fears in children with ASD because
they are common and can interfere significantly with functioning.
Specific fears and phobias have been cited as frequent anxiety triggers/stressors
for children with ASD. The impact of anxiety includes personal distress in children,
parents, and siblings, increase in challenging behavior and stereotyped
behaviors, restriction of activities/opportunities and negative impact on quality of life for child and
family. For example, children with autism may avoid necessary life
situations (e.g., refusing to go to school because there may be a fire drill)
or be in a constant state of anxiety and unable to function optimally because
of their fears.

Identification of specific fears and phobias can
help educators and interventionists improve programs and services for children on the autism spectrum. This information may be especially useful for clinicians,
particularly those utilizing CBT as a treatment approach for children and youth
with ASD. There is
evidence to suggest that the interventions used to treat intense fears and phobias
in children without autism (exposure, desensitization, modeling, shaping, and reinforcement)
might also be effective for children who have autism. Lastly, further research
is needed to investigate why some specific unusual fears are common to autism
but not the general population. As more individuals with ASD communicate about
their fears and reasons for their idiosyncrasies, we may come to a better understanding
of autism and its symptoms.

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The objective of bestpracticeautism.com is to advocate, educate, and informby providing a best practice guide to the screening, assessment, and intervention for school-age children on the autism spectrum. Timely articles and postings include topics such as screening, evaluation, positive behavior support (PBS), self-management, educational planning, IEP development, gender differences, evidence-based interventions (EBI) and more. This site also features up-to-date information on scientifically validated treatment options for children with ASD and a list of best practice books, articles, and links to organizations. Designed to be a practical and useful resource, bestpracticeautism.com offers essential information for psychologists, teachers, counselors, advocates and attorneys, special education professionals, and parents.

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